Beginning 1 October 2008, Medicare will no longer pay hospitals for treating preventable errors. The new ruling lists eight specific conditions for which payment will be withheld:
- Retrieval of surgical tools or sponges left in a patient
- Surgical site infection after coronary artery bypass surgery
- Injuries caused by falls in hospitals
- Infections caused by prolonged use of catheters n the bladder or blood vessels
- Treatment for bedsores developed in hospital
- Extra care for patients harmed by incompatible blood/li>
- Extra care for patients harmed by air embolisms
The hope is that this change will encourage hospitals to pay more attention to common-sense precautions to prevent these conditions. The Centers for Disease Controls and Prevention estimates
“…that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year – about 270 a day.”
- The New York Times, 19 August 2007
Wall Street analysts are not so sure that loss of income, estimated at about $20 million per year spread over just under 5,000 hospitals in the U.S., is incentive enough for hospitals to reduce errors.
“Medicare pays hospitals over $100 billion a year, so $20 million is less than 0.02%,” [says Bear Stearns analyst Jason] Gurda…”I’m not expecting a significant impact although it is a first step toward paying for quality.”
- CNNmoney.com, 17 August 2007
According to Investor’s Business Daily reprinted at cnnmoney.com, private insurers follow Medicare’s lead and they may also stop paying for treatment for hospital medical errors.
Hospitals are concerned that they will need to absorb the costs of additional tests to determine what infections or conditions are present when a patient is admitted. Fortunately, the new Medicare ruling disallows “shifting costs of preventable errors to patients or their insurers”, according to The New York Times.
Overall, this appears to be a good move to light a fire under hospital workers to improve what most of us would consider basic hygiene practices. A three-year-old study published in the Annals of Internal Medicine reports:
“Doctors cleansed their hands 57% of the times that they should have. They cleansed hands most often when a hand-rub solution was easily available.
“They did not wash hands as often when they had busy workloads with many patient interactions and when they performed activities with high risks for spreading infections. These activities required cleansing hands immediately before examining patients or between examining different body sites on the same patient.
“Medical students and internists (internal medicine doctors) washed hands most often, whereas anesthesiologists, critical care physicians, and surgeons washed hands least often. Doctors who valued hand hygiene and considered themselves role models washed hands often.”
[At The Elder Storytelling Place today, Celia Jones explains how well experience applies - or not - in Old Hands at Minding New Granddaughter.]